Thursday, April 5, 2012

Euthanasia Coming to Quebec?

A report from a legislative committee in Quebec reads like a pro-euthanasia manifesto, not an unbiased study. That's the opinion of
Margaret Somerville, the founding director of the Centre for Medicine, Ethics and Law at McGill University. Here is what she has to say:

Will Quebec Legalize Euthanasia?

By Margaret Somerville

Before society responds affirmatively to the call for legalized euthanasia,
we will need to provide the public with a more full and open explanation of the
case against it. The recent Quebec National Assembly committee report Dying with
Dignity fails to do that.

Like the previous report of the expert panel of the Royal Society of Canada
on this same subject, the Quebec report is not balanced and reads rather like a
pro-euthanasia manifesto. The fact that it strongly recommends palliative care
does not negate that characterization. The Quebec report takes a purely
utilitarian approach to the euthanasia question. In the committee’s estimation,
legalizing euthanasia will do more good than harm -- and that justifies allowing
it.

It upholds respect for individuals’ rights to autonomy and self-determination
as the overriding value, citing, among other examples, the current approach to
abortion as showing this value predominates in contemporary Quebec society.

The committee concludes that legalizing euthanasia will not harm the value of
respect for life, because euthanasia will only be used in exceptional
circumstances and there will be very few cases. And in any case, “La valeur du
caractère sacré de la vie a subi une transformation notable” ("The value of the
sanctity of life has undergone a significant transformation") relative to other
values, which means that now respect for life itself doesn’t necessarily take
priority.

The committee argues that allowing euthanasia is merely an incremental change
--- we all agree with palliative care and, it says, “aide medicale a mourir”
(euthanasia) needs to be seen as just another “palliative-care option.”

How should we respond to these arguments?

First, many people who oppose legalizing euthanasia do so because they
believe it’s inherently wrong to kill another person, except when that is the
only way in which to protect innocent human life. Euthanasia does not fall
within this exception and, therefore, for them, can never be ethically
justified.

The clash of values involved in the euthanasia debate is between, on the one
hand, respect for life, both individual human life and human life in general;
and, on the other hand, individuals’ rights to autonomy and self-determination.
People who reject euthanasia give priority to respect for life; people who
support euthanasia give priority to autonomy and self-determination.

“Respect for life” must be upheld at two levels: respect for each individual
human life and respect for human life, in general. The latter requirement is the
reason that the consent of an individual to being euthanized is not sufficient
to avoid damaging the value of respect for life. Authorizing doctors to kill
their patients necessarily contravenes respect for human life, in general.

And, even if the committee’s reassurance that cases of euthanasia will be
exceptional and, therefore, not damage the value of respect for life, indeed,
even if there were only one case, legalizing euthanasia still involves crossing
the line established by the fundamental rule that we must not intentionally kill
each other.
In short, it would unavoidably harm the value of respect for life, which
means that legalizing euthanasia involves a radical change in our society’s
values.

Pro-euthanasia advocates often argue that seeing life as “sacred” is a
religious value and, because of that, should not be taken into account in the
public square. Whatever one’s views are in that regard, respect for life is not
just a religious value; it’s a foundational value of all societies in which
reasonable people would want to live.

Concern about the consequences of legalizing euthanasia raises the question
of whether a utilitarian case against euthanasia can be made. Exploring
that question shows that the utilitarian case for euthanasia is not
nearly as strong as the committee argues it is. Many seriously harmful
consequences from legalizing euthanasia could far outweigh any benefits it might
have.

Apart from its harmful impact on the societal value of respect for life, it
would harm the institutions of law and medicine, and the healthcare professions.
Can we even imagine teaching medical students how to kill their patients?

The committee recognizes the serious danger of the abuse of euthanasia must
be taken into account and proposes safeguards. However, contrary to what the
committee states, experience with euthanasia in the Netherlands and Belgium is
not strongly reassuring that such safeguards are effective.

The committee adopts the strategy used by advocates of legalizing euthanasia
of confusing it with interventions that are not euthanasia and are ethically and
legally acceptable. For instance, it tells us that in accepting, as we do in
some cases, the withdrawal of life-support treatment to allow a person to die,
we are already practicing euthanasia; therefore, legalizing euthanasia is just a
small step forward. These are false and misleading analogies and a false and
misleading line of argument. There is a radical difference between killing a
person and allowing them to die of natural causes.

In proposing to replace the word euthanasia with the term “aide médicale à
mourir,” the committee introduces a euphemism that both trivializes and is
likely to conceal the moral and ethical issues. Terminology matters because our
emotional responses and moral intuitions play an important role in helping us to
decide what is ethical and what is not and the language we use affects these
responses: compare “physician assisted death” with “doctors killing their
patients”.

If we are to have a discussion about euthanasia, it must be an unbiased one.
It’s hard for me to conclude from its report that the National Assembly
committee undertook such an unbiased reflection, especially in view of the fact
that two-thirds of the submissions it received argued against legalizing
euthanasia.